The policy implications of measuring performance among health plans for alcohol and other drug (AOD) treatment are far reaching. Critical issues include: (1) technical and methodologic development of measures, (2) interpretation of measures, (3) adoption of measures, and (4) utilization of measures to achieve change. A pilot study for the Washington Circle Group with six health plans suggests that technical feasibility is possible using relatively accessible plan data. Interpretation of measures is an important policy challenge. Comparison of plan data with national norms is desirable and will require development. For example, the 1998 National Household Survey on Drug Abuse indicated that 4-5% Americans were in need of AOD care. In contrast, pilot testing showed that the percentage identified as with AOD diagnoses in six managed care organizations was 0.72 to 1.45 percent. Factors that are unrelated to performance (e.g., assessment methodology and sample differences) will need to be accounted for. Adoption of measures will involve dissemination, review, and testing by a broad array of stakeholders, including consumers, employers, governmental agencies, and researchers. To achieve change, it will be necessary for oversight groups to implement AOD performance measures as standards of comparison, either for purposes of relative comparison among plans, or for evaluating plans according to minimum performance thresholds. Given the serious societal implications of AOD diseases and the vital responsibilities health plans underwrite for effective care, performance measures in AOD are likely to serve potential roles in quality improvement, accreditation standards, and contract specifications.

Learning Objectives:

At the end of this presentation, participants will understand the policy implications of performance measures for substance abuse.

Presenting author's disclosure statement:I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.